Nutritional Care in Iranian Intensive Care Units

Intensive care units (ICUs) provides intensive treatment medicine to avoid complications such as malnutrition, infection and even death. As very little is currently known about the nutritional practices in Iranian ICUs, this study attempted to assess the various aspects of current nutrition support practices in Iranian ICUs. We conducted a cross-sectional study on 150 critically ill patients at 18 ICUs in 12 hospitals located in 2 provinces of Iran from February 2015 to March 2016. Data were collected through interview with supervisors of ICUs, medical record reviews and direct observation of patients during feeding. Our study showed that hospital-prepared enteral tube feeding formulas are the main formulas used in Iranian hospitals. None of the dietitians worked exclusively an ICU and only 30% of patients received diet counselling. Regular monitoring of nutritional status, daily energy and protein intake were not recorded in any of the participating ICUs. Patients were not monitored for anthropometric measurements such as mid-arm circumference (MAC) and electrolyte status. The nasogastric tube was not switched to percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEGJ) in approximately 85% of patients receiving long-term enteral nutrition (EN) support. Our findings demonstrated that the quality of nutritional care was inappropriate in Iranian ICUs and improvement of nutritional care services within Iranian ICUs is necessary.

Anthropometric Indices from Primary to High School in the West of Iran: Epidemiologic Trends

Examining the trend of anthropometric indices in children and adolescents in each region can be highly beneficial in providing effective strategies to improve the status of their growth. This study was conducted with the aim of determining the trend of anthropometric indices in students from primary to high school in the west of Iran. Data were collected using a demographic questionnaire and health certificates for anthropometric information of primary school students, and current anthropometric measurements with scale for high school students. Then, all of the data were analyzed in AnthroPlus and SPSS software. Of the 731 students, 350 were female and 381 were male. Mean height Z-score to age showed a significant reduction from primary to high school (from +0.0386 to −0.27416), and mean body mass index Z-score to age showed a significant increase (from −0.3916 to +0.1826). Prevalence of stunting and overweight/obesity in high school was 1.4 and 2.5 times higher than primary school, respectively, but the prevalence of wasting reduced by 2.3 fold. Girls were more affected by the increased trend of obesity and stunting compared to boys. Nutritional transition was evident in students. Healthcare policy-makers should design and implement a comprehensive health strategy to deal with this situation, especially in girls.

Comparison of 3 Nutritional Questionnaires to Determine Energy Intake Accuracy in Iranian Adults

A precision instrument is required to assess the nutritional status. This study was conducted on comparison of 3 nutritional questionnaires to determine energy intake (EI) accuracy in adults in Ravansar Non-Communicable Chronic Disease (RaNCD) cohort study. This cross-sectional study was conducted on 118 of participant's RaNCD. EI was evaluated with 3 questionnaires including food frequency questionnaire (FFQ), 24-hours recall (24HR), and food habits questionnaire (FHQ). Resting metabolic rate (RMR) was measured using indirect calorimetry. We used EI/RMR cut off to evaluate EI reporting status. The mean ± standard deviation of age in men and women were 44.1 ± 6.5 and 43.7 ± 5.25 respectively and 50.8% of participants were men. Among 3 EI estimating questionnaires, FFQ was more accurate than 2 other questionnaires (67.8%). We observed that implausible reporters of 24HR were likely overweight (p < 0.005) but we did not observe a significant difference between EI reporting of FFQ and FHQ with participants' body composition. Our finding showed that EI underreporting of 24HR and FHQ were high. Under reporters were seemed to be overweight. Therefore, these results suggested that among 3 nutritional questionnaires the FFQ was an appropriate approach to determine EI in this population due to plausible EI reporting was higher than 2 other nutritional questionnaires (24HR and FHQ).

Dietary Diversity Score and Its Related Factors among Employees of Kermanshah University of Medical Sciences

Dietary diversity score (DDS) is known as an indicator of food quality. Dietary diversity can promote health status. The aim of this study was determined DDS and its related factors in Kermanshah University of Medical Sciences (KUMS) employees. This cross-sectional study was conducted on 190 employees of KUMS in 2015. According to the population of KUMS centers which were selected randomly (Paramedical, Public Health faculties, Imam Reza Hospital and province health center), subjects were selected by convenience sampling method. Food frequency questionnaire (FFQ) was used to calculate DDS. Foods were divided into 5 main groups: grains, vegetables, fruits, meat, and dairy products. The main groups had 23 subgroups. Total DDS divided to 4 quartiles: less than 3.0, 3.0–5.5, 5.6–8.5, and more than 8.5. Anthropometric parameters including: weight, height, waist circumference (WC), and hip circumference were measured. Data were analyzed by Kolmogorov-Smirnov test, χ² test, and analysis of variance (ANOVA) test with SPSS 20 software (IBM Corp., Chicago, IL, USA). The mean ± standard deviation of DDS and body mass index (BMI) were 5.68 ± 1.73 and 25.1 ± 3.42 kg/m², respectively. The average of the waist-to-hip ratio (WHR) in men and women was 0.92 ± 0.04 and 0.86 ± 0.06, respectively. There was statistically significant difference between DDS and self-reported economic status (p < 0.022). No significant difference was observed between DDS and BMI or WC. However, significant negative correlation was observed between DDS and WHR in men (p < 0.019). This study showed that DDS had a negative correlation with the WHR. Therefore, dietary diversity may improve health status by effect on fat distribution in body.

[Nutritional Status of Working Children in Kermanshah, 2013]

Background: Starting to work from early age can have negative impact on the growth and nutritional status, especially if the children are employed in dangerous jobs. This study aimed to assess nutritional status and growth in working children who were working in Kermanshah.

Materials and Methods: This survey was a case-control study that wasdoneon90 working childrenand90not- working children in Kermanshah. Information related to anthropometric indices with measurements of height and weight, demographic data using demographic questionnaire and food intake using food frequency questionnaire were collected. To compare growth of children with standards we use body mass index percentiles for sex and age provided by Centres for Disease Control and Prevention [CDC].Data analysis was performed using SPSS software version 16.

Results: Mean of age working children was 16.4 +/- 1.8 years and 15.7% of them were illiterate. Consumption of all food groups except the miscellaneous group in working children was significantly lower than not- working children[p<0.001].The prevalence of stunting in working children was 10% more than the not- working children. The prevalence of malnutrition based on body mass index in working children[36.1%], was approximately 50% more than the not- working children[16.5%], [P <0.01].

Conclusion: The finding so this study showed that indicators of nutritional status in working children have not favourable condition. This could bea risk factor for health of this group of children and a warning for affecting of them by kind of disease.